Polyaxial bone screw

ABSTRACT

The present invention generally provides a polyaxial fixation device having a shank with a spherical head formed on a proximal end thereof, and a receiver member having an axial passage formed therein that is adapted to polyaxially seat the spherical head of the shank. The polyaxial bone screw further includes an engagement member that is adapted to provide sufficient friction between the spherical head and the receiver member to enable the shank to be maintained in a desired angular orientation before locking the spherical head within the receiver member.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.13/657,486, filed on Oct. 22, 2012 entitled “Polyaxial Bone Screw,”which is a continuation of U.S. patent application Ser. No. 12/698,612(now U.S. Pat. No. 8,313,516) filed on Feb. 2, 2010 and entitled“Polyaxial Bone Screw,” which is a continuation of U.S. patentapplication Ser. No. 11/381,048 (now U.S. Pat. No. 7,682,377) filed onMay 1, 2006 and entitled “Polyaxial Bone Screw,” which is a continuationof U.S. patent application Ser. No. 10/608,904 (now U.S. Pat. No.7,087,057) filed on Jun. 27, 2003 and entitled “Polyaxial Bone Screw,”which are hereby incorporated by reference in their entireties.

FIELD OF THE INVENTION

The present invention relates to polyaxial bone screws, and inparticular to a polyaxial bone screw assembly in which the bone screwcan be maintained in a desired angular orientation prior to locking thebone screw with respect to the rod-receiving member.

BACKGROUND OF THE INVENTION

Spinal fixation devices are used in orthopedic surgery to align and/orfix a desired relationship between adjacent vertebral bodies. Suchdevices typically include a spinal fixation element, such as arelatively rigid fixation rod, that is coupled to adjacent vertebrae byattaching the element to various anchoring devices, such as hooks,bolts, wires, or screws. The fixation rods can have a predeterminedcontour that has been designed according to the properties of the targetimplantation site, and once installed, the instrument holds thevertebrae in a desired spatial relationship, either until desiredhealing or spinal fusion has taken place, or for some longer period oftime.

Spinal fixation devices can be anchored to specific portions of thevertebra. Since each vertebra varies in shape and size, a variety ofanchoring devices have been developed to facilitate engagement of aparticular portion of the bone. Pedicle screw assemblies, for example,have a shape and size that is configured to engage pedicle bone. Suchscrews typically include a bone screw with a threaded shank that isadapted to be threaded into a vertebra, and a rod-receiving element,usually in the form of a U-shaped slot formed in the head. The shank androd-receiving assembly can be provided as a monoaxial screw, whereby therod-receiving element is fixed with respect to the shank, or a polyaxialscrew, whereby the rod-receiving element has free angular movement withrespect to the shank. In use, the shank portion of each screw isthreaded into a vertebra, and once properly positioned, a fixation rodis seated into the rod-receiving element of each screw. The rod is thenlocked in place by tightening a set-screw, plug, or similar type offastening mechanism into the rod-receiving element.

While current spinal fixation systems have proven effective, it can bedifficult to mount rods into the rod-receiving element of variousfixation devices. In particular, it can be difficult to align and seat arod into the rod-receiver of a polyaxial implant since the rod-receiverhas polyaxial freedom of movement with respect to the shank. Moreparticularly, the polyaxial freedom of movement of the rod-receiver canallow the receiver to “flop,” thereby requiring the surgeon or anassistant to hold the receiver in the desired position during rodintroduction.

Accordingly, there remains a need for a polyaxial bone screw assembly inwhich the rod-receiving element can be maintained in a desired angularorientation before locking the shank with respect to the receivermember.

SUMMARY OF THE INVENTION

The present invention generally provides a polyaxial spinal fixationdevice (e.g., bone screws, hooks, etc.) having a shank with a sphericalhead formed on a proximal end thereof, and a receiver member having anaxial passage formed therein that is adapted to polyaxially seat thespherical head of the shank. The polyaxial fixation device furtherincludes an engagement member that is adapted to provide sufficientfriction between the spherical head and the receiver member to enablethe shank to be maintained in a desired angular orientation beforelocking the spherical head within the receiver member. The engagementmember can have a variety of configurations, and in one embodiment theengagement member can be a ring member, such as a snap ring, that ispositioned to engage a portion of the spherical head to providefrictional engagement between the head and the receiver member. The ringmember can be disposed within a groove formed around an outer surface ofthe spherical head of the shank, and/or it can be disposed within agroove formed around an inner surface of the receiver member. The groovearound the inner surface of the receiver member preferably has a depththat is equal to or greater than a thickness of the ring member to allowthe ring member to be completely disposed within the groove.Alternatively, or in addition, the ring member can be adapted to expandor contract to be disposed completely within the groove.

In another embodiment, the engagement member can be a compression capthat is disposed within the receiver member and that has a concavedistal surface adapted to seat at least a portion of the spherical headof the shank. The compression cap is preferably capable of mating withthe receiver member such that the compression cap is effective to retainthe spherical head of the shank in a spherical recess formed in thereceiver member. The compression cap can have a variety ofconfigurations, and in one embodiment it can include opposed leaf-springmembers that are adapted to contract inward, biasing the cap distally,to frictionally engage the spherical head of the shank. In anotherembodiment, at least a portion of the compression cap has a diameterthat is expandable to frictionally engage the spherical head. By way ofnon-limiting example, the compression cap can include a plurality ofdistally-extending finger-like members formed around a distal edge ofthe compression cap to frictionally engage the spherical head. In yetanother embodiment, the compression cap can include at least onelongitudinally oriented slot formed therein to allow the compression capto be contracted to frictionally engage the spherical head.

In other aspects, a polyaxial fixation assembly is provided having ashank with a spherical head formed on a proximal end thereof, and areceiver member having a first, proximal opening adapted to receive aspinal fixation rod and a second, distal opening having a diameter sizedto permit passage of the shank therethrough while maintaining thespherical head therein. The receiver member further includes a sphericalseat adjacent the second, distal opening to polyaxially seat thespherical head of the shank. The polyaxial fixation assembly alsoincludes means for frictionally engaging the spherical head to maintainthe shank in a desired angular orientation such that a force greaterthan a frictional engagement force is required to change the angularorientation of the threaded shank with respect to the receiver member.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of a prior art polyaxial bone screw;

FIG. 2A is an enlarged, partially cross-sectional view of a polyaxialbone screw assembly having a ring member disposed therein in accordancewith one embodiment of the present invention;

FIG. 2B illustrates several embodiments of a ring member that can beused with the polyaxial bone screw assembly shown in FIG. 2A;

FIG. 2C is an illustration of another embodiment of a bone screw havinga ring member disposed therearound;

FIG. 3A is a perspective view of a polyaxial bone screw assembly, in thedisassembled state, having a compression cap with a collet for engagingthe head of a bone screw in accordance with another embodiment of thepresent invention;

FIG. 3B is an enlarged, partially cross-sectional view of a portion ofthe polyaxial bone screw assembly shown in FIG. 3A;

FIG. 3C illustrates the polyaxial bone screw assembly of FIG. 3B with arod and closure mechanism disposed therein;

FIG. 4A is a perspective view of another embodiment of a polyaxial bonescrew assembly, in the disassembled state, having a compression cap witha leaf-spring for engaging the head of a bone screw in accordance withthe present invention;

FIG. 4B is an enlarged, cross-sectional view of the a portion of thepolyaxial bone screw assembly shown in FIG. 4A;

FIG. 5A is a perspective view of yet another embodiment of a polyaxialbone screw assembly, in the disassembled state, having a compression capwith a slot formed therein to allow the compression cap to engage thehead of a bone screw in accordance with the present invention; and

FIG. 5B is an enlarged, partially cross-sectional view of a portion ofthe polyaxial bone screw shown in FIG. 5A.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 illustrates a prior art polyaxial bone screw assembly 10 thatincludes a bone screw 12, a receiver member 18, and a compression cap24. As shown, the bone screw 12 generally includes a threaded shank 14having a spherical head 16 formed on a proximal end 14 a thereof. AnAllen or other female socket 15 is formed in the head 16 for applyingtorque along the axis of the shank 14 to insert the shank 14 into bone.The receiver member 18 is generally U-shaped and includes opposed sidewalls or legs 20 a, 20 b that are substantially parallel to one anotherand that define a rod-receiving portion 22 for seating a spinal fixationrod. A distal end 18 b of the receiver member 18 includes an axialopening (not shown) formed therein and having a diameter sized to permitpassage of the shank 14 therethrough while maintaining the sphericalhead 16 therein. The receiver member 18 further includes a sphericalseat (not shown) adjacent to the distal opening for polyaxially seatingthe spherical head 16 of the bone screw 12. The compression cap 24,which is adapted to be positioned within the receiver member 18, has agenerally cylindrical shape and includes a rod-receiving proximalsurface 26, and a concave distal surface (not shown) that is adapted tofit around and seat a portion of the spherical head 16 of the bone screw12.

In use, the threaded shank 14 is disposed through the distal opening inthe receiver member 18 and the spherical head 16 of the bone screw 12 ispositioned within the spherical seat in the receiver member 18. Thecompression cap 24 is then inserted into the receiver member 18 suchthat the concave distal surface of the compression cap 24 is disposedaround and seats a portion of the spherical head 16 of the bone screw12. In order to retain the compression cap 24 within the receiver member18, the receiver member 18 includes opposed sides bores (only one sidebore 28 a is shown) having a deformable material (not shown) extendingthere across on an inner surface of the receiver member 18. The sidebores 28 a allow the material to be deformed inward to extend into andengage opposed detents (only one detent 30 a is shown) formed in thecompression cap 24. A tool can be used to deform the material into thedetents 30 a once the compression cap 24 is disposed within the receiver18. As a result, the compression cap 24 is maintained within thereceiver member 18, thereby preventing removal of the bone screw 12 fromthe receiver member 18. The compression cap 24 is also effective to lockthe bone screw 12 in a desired angular orientation with respect to thereceiver member 18 once a rod is disposed and locked within the receivermember 18. A person skilled in the art will appreciate that a variety oftechniques can be used to retain the compression cap 24 within thereceiver member 18, and that the present invention is not intended to belimited to use with compression caps 24 having detents for receivingdeformable material disposed within the receiver member. By way ofnon-limiting example, the compression cap 24 can be retained within thereceiver 18 using a cross-pin.

Once the bone screw 12 is implanted within bone, and prior to insertionof a rod into the receiver member 18, the receiver member 18 of theprior art assembly is free to rotate and/or be angularly positioned withrespect to the bone screw 12. While this advantageously allows alignmentof the receiver member 18 with a rod adapted to be disposed therein,such free axial movement of the receiver member 18 can presentchallenges during surgery as the surgeon is required to hold thereceiver member 18 in the desired position during rod introduction.

Accordingly, the present invention provides mechanisms for creatingfriction between the spherical head 16 and the receiver member 18 toallow the receiver member 18 to be provisionally maintained in a desiredangular orientation prior to locking the receiver member 18 with respectto the a polyaxial fixation device. This is particularly advantageous inthat it allows a surgeon to position and maintain the receiver member 18in a desired orientation prior to rod introduction, thereby preventingthe receiver member 18 from moving with respect to the bone screw 12during introduction of a rod. While several different techniques can beused to create the necessary frictional forces to allow the angularorientation between the receiver member 18 and the bone screw 12 to bemaintained, FIGS. 2A-5B illustrate several exemplary embodiments forfrictionally engaging the spherical head of a bone screw with respect toa rod-receiver member. For convenience purposes, the reference numbersused in the embodiments shown in FIGS. 2A-5B correspond to the referencenumbers used in FIG. 1, except that a different prefix is added to thereference numbers for each embodiment. A person skilled in the art willappreciate that a variety of other techniques can be used to create thefrictional forces necessary to maintain the angular orientation of theshank with respect to the receiver member. Moreover, the techniques usedto create friction between the spherical head and the receiver membercan be adapted for use with virtually any polyaxial spinal fixationdevice in addition to the illustrated bone screw assembly, and theinvention is not intended to be limited to the specific polyaxial bonescrew assembly shown.

FIG. 2A illustrates one embodiment of a polyaxial bone screw assembly210 that utilizes a ring member, e.g., a snap ring 234, to frictionallyengage the spherical head 216 of the bone screw 212. The snap ring 234can have a variety of configurations, shapes, and sizes, but it shouldbe adapted to expand to fit around at least a portion of the sphericalhead 216. As shown, the snap ring 234 is in the shape of a loop with anopening 235 formed therein that allows the diameter d of the snap ring234 to expand to fit around a portion of the spherical head 216 of thebone screw 212. While the snap ring 234 is shown having a C-shape, thesnap ring can 234 can have a variety of other configurations. By way ofnon-limiting example, FIG. 2B illustrates a variety of different snaprings 234 a, 234 b, 234 c, 234 d, 234 e that can be used with thepolyaxial bone screw assembly 210 shown in FIG. 2A. Snap rings 234 a and234 c, for example, each have an irregular shape that allows the snaprings 234 a, 234 c to expand to fit around the spherical head 216 of thebone screw 212. Snap ring 234 e, on the other hand, includes severalcut-out portions 235 e that allow the snap ring 234 e to expand. Inother embodiments, the snap ring 234 can have a variety of differentcross-sectional shapes such as, for example, a circular cross-sectionalshape as shown on snap ring 234 d, or a C-shaped cross-section as shownon snap ring 234 b.

While the snap ring 234 can have a variety of configurations, the snapring 234 should be adapted to fit within a corresponding groove 236formed around an inner surface of the receiver member 218. The groove236 maintains the snap ring 234 at a particular location with respect tothe spherical head 216 of the bone screw such that the snap ring 234 isexpanded around the head 216. More particularly, the groove 236 shouldbe formed in a proximal portion of the spherical seat 219 formed in thedistal end 218 b of the receiver member 218. Not only is the groove 236effective to maintain the position of the snap ring 234 around thespherical head 216, but it is also effective to fully seat the snap ring234 when the head 216 is locked within the receiver 218. As previouslydiscussed, when a rod is seated within the receiver member 218, thecompression cap 224 is forced distally to lock the bone screw 216 withrespect to the receiver 218. The groove 236 receives the snap ring 234to prevent the snap ring 234 from interfering with the locking functionof the compression cap 224. Accordingly, the groove 236 preferably has adepth d₁ that is at least equal to, and more preferably is greater than,a thickness t_(r) of the snap ring 234. Alternatively, or in addition,the snap ring 234 can be adapted to expand or contract to be completelydisposed within the groove 236. By way of non-limiting example, the snapring 234 can be formed from a compressible or deformable material thatallows the snap ring 234 to be forced completely into the groove 236.

Still referring to FIG. 2A, the bone screw assembly 210 can be assembledby first placing the snap ring 234 within the groove 236 in the receivermember 218. The threaded shank 214 of the screw 212 can then be insertedthrough the axial opening 237 formed in the distal end 218 b of thereceiver member 218. As a result, the spherical head 216 will rest ontop of the snap ring 234. The compression cap 224 can then be placed inthe receiver 218 and can be used to push the head 216 into the recess219, thereby causing the snap ring 234 to expand around the head 216 toengage the head 216. This can be achieved by using a tool to push thecompression cap 224 in a distal direction. To prevent the compressioncap 224 from popping out of the receiver 218, another tool can beinserted into each of the opposed bores 228 a, 228 b to deform thedeformable material 232 a, 232 b, which extends across the inner surfaceof the receiver member 218, into the corresponding detents 230 a, 230 bformed in the compression cap 224. As a result, the compression cap 224is prevented from moving in a proximal direction, thereby preventing thespherical head 216 from moving proximally and becoming disengaged withthe snap ring 234. One skilled in the art will appreciate that a varietyof other techniques and fastening members are known for use in retainingthe spherical head 216 (and any rod) within the receiver 218.

Once the device 210 is assembled, the frictional forces created by thesnap ring 234 that act on the spherical head 216 of the screw 212 willallow the screw 212 to be set at a desired angular orientation withrespect to the receiver member 218, as shown in FIG. 2A. The frictionalforces can simply be overcome by grasping and moving the bone screw 212with respect to the receiver member 218 to change the angularorientation. In other words, a force greater than the frictionalengagement force is required to change the angular orientation of thebone screw 212 with respect to the receiver member 218.

In another embodiment, shown in FIG. 2C, the snap ring 234 can bedisposed within a groove 236′ formed around the spherical head 216′ ofthe bone screw 212′, rather than in a groove 236 formed within thereceiver member 218. In this embodiment, the groove 236′ around the head216′ of the bone screw 212′ preferably extends at an angle a, withrespect to a longitudinal axis L of the screw 212′, around the proximalhalf of the spherical head 216′ to allow the head 216′ to fit within thespherical recess 219 in the receiver member 218. The angle α of thegroove 236′ also allows the snap ring 234 to bear against the concaveinner surface of the compression cap 224, thereby creating the necessaryfrictional forces to allow the angular orientation of the bone screw212′ to be maintained with respect to the receiver member 218.

FIGS. 3A-3C illustrate another embodiment of a polyaxial bone screwassembly 310 that includes an engagement feature that is effective tomaintain the angular orientation of a bone screw 312 with respect to areceiver member 318. In this embodiment, rather than providing aseparate engagement member, such as snap ring 234 shown in FIGS. 2A-2C,the compression cap 324 is modified to include an expandable portionthat is adapted to fit around and frictionally engage the spherical head316 of the bone screw 312. While the expandable portion can havevirtually any configuration, in an exemplary embodiment the distal end324 b of the compression cap 324 includes a collet 333 formedtherearound having several spaced apart finger-like members 334 that areseparated by slots 335 which allow the finger-like members 334 toexpand. The collet 333 can include any number of finger-like members 334that can be spaced apart at varying distances. Once the cap is retainedin place within the receiver member, the fingers 334 will bear upon thespherical head 316 of the screw 312. This can be achieved by deformingthe fingers 334 on the cap inward prior to assembly, so that theycontact the spherical head 316 of the screw 312 once inserted.Alternatively, the concave underside of the cap 324 can be machined sothat the radius is smaller than a radius r of the spherical head 316 ofthe screw 312. This interference will also cause the fingers 334 to bearupon the head 316 of the screw 312. In use, as the compression cap 324is moved distally on to the head 316, the collet 333 is forced to expandaround the spherical head 316 of the bone screw 312 to engage the headand create the friction necessary to maintain the angular orientation ofthe screw 312 with respect to the receiver 318, as shown in FIG. 3B. Aspreviously indicated, the compression cap 324 can be retained in thisposition by deforming the material 332 a, 332 b in the receiver member318 into the corresponding detents 330 a, 330 b in the compression cap324.

Still referring to FIG. 3B, in a further embodiment, the receiver member318 can include an annular groove 336 formed therein for receiving theexpandable fingers 334 of the collet 333. The groove 336, which issimilar to groove 236 shown in FIG. 2A, prevents the collet 333 frominterfering with the locking function of the compression cap 324. Inother words, when a rod 50 is seated within the rod-receiving recess 326formed in the compression cap 324, and a closure mechanism 60 is appliedto lock the rod 50 within the receiver member 318, as shown in FIG. 3C,the compression cap 324 locks the position of spherical head 316 withinthe receiver member 318. The groove 336 thus receives the collet 333 toprevent the collet 333 from interfering with the locking forces createdbetween the compression cap 324 and the spherical head 316.

FIGS. 4A-4B illustrate yet another embodiment of a polyaxial bone screwassembly 410 in which a leaf-spring compression cap 424 is used toengage the spherical head 416 of the bone screw 412 to create thefrictional forces necessary to maintain the angular orientation of thebone screw 412 with respect to a receiver member 418. As shown in FIG.4A, the compression cap 424 includes a first pair of slots 431 a ₁, 431a ₂ formed on opposed sides of the first detent 430 a, and a second pairof slots 431 b ₁, 431 b ₂ formed on opposed sides of the second detent430 b. Each pair of slots 431 a ₁, 431 a ₂, 431 b ₁, 431 b ₂ extendsfrom a proximal end 424 a of the compression cap 424 toward the distalend 424 b, terminating just proximal to the distal end 424 b. As aresult, the slots 431 a ₁, 431 a ₂, 431 b ₁, 431 b ₂ form sidewallportions 434 a, 434 b therebetween that are flexible, thereby forming aleaf spring. In use, as shown in FIG. 4B, when the deformable material432 a, 432 b in the receiver member 418 is deformed into thecorresponding detents 430 a, 430 b in the compression cap 424, thesidewall portions 434 a, 434 b flex inward thereby contracting around,and preferably creating a downward pressure on, the spherical head 416of the bone screw 412. As a result, friction is created between thecompression cap 424 and the spherical head 416 to maintain the angularorientation of the screw 412 with respect to the receiver member 418. Aperson skilled in the art will appreciate that a variety of othertechniques can be used to create a spring-like compression cap 424 thatis effective to engage the spherical head 416 of the screw 412.

FIGS. 5A-5B illustrate yet another embodiment of a polyaxial bone screwassembly 510. In this embodiment, the compression cap 524 includes anaxial slot 534 formed therein to allow the compression cap 524 to becontracted to engage the spherical head 516 of the bone screw 512. Whilethe slot 534 can be formed anywhere in the compression cap 524, the slot534 is preferably formed in the portion of the sidewall that extendsbetween the opposed detents 530 a, 530 b, and more preferably the slot534 is equidistant from each detent 530 a, 530 b to allow thecompression cap 524 to be swaged evenly in a distal direction. FIG. 5Billustrates the compression cap 524 in the contracted state around thehead 516 of the bone screw. The deformable material 532 a, 532 b in thereceiver member 518 is deformed into the detents 530 a, 530 b in thecompression cap 524 to contract the compression cap 524 around thespherical head 516. As a result, the frictional forces created by thecompression cap 524 radially contracting around the spherical head 516are effective to allow the bone screw 512 to be maintained at a desiredangular orientation with respect to the receiver member 518.

A person skilled in the art will appreciate that a variety of othertechniques can be used to apply friction to the spherical head of apolyaxial bone screw to allow the bone screw to be maintained in adesired angular orientation before locking the bone screw within thereceiver member. By way of non-limiting example, the spherical head ofthe polyaxial screw can include a coating or surface treatment thereonto hinder movement of the screw head with respect to the receivermember. Alternatively, or in addition, the spherical head, thecompression cap, and/or the receiver member can include one or moreprotrusions formed thereon to frictionally engage the spherical head toallow the orientation of the head to be maintained in a desiredconfiguration. The protrusions can be, for example, formed from aplastic material that is effective to interfere with the free rotationalmovement of the screw within the receiver.

A person skilled in the art will appreciate that this design isapplicable to other polyaxial fixation devices, including other screws,cross-connectors, hooks, bolts, etc., and it is not intended to belimited to use with a polyaxial bone screw. A person skilled in the artwill also appreciate further features and advantages of the inventionbased on the above-described embodiments. Accordingly, the invention isnot to be limited by what has been particularly shown and described,except as indicated by the appended claims. All publications andreferences cited herein are expressly incorporated herein by referencein their entirety.

1-20. (canceled)
 21. A polyaxial fixation device, comprising: a receiver member having opposed arms that define a rod-receiving recess therebetween, a recess formed in a distal end thereof, and an annular groove formed in an internal surface thereof; a bone screw having a head seated within the recess in the receiver member such that the head is substantially distal to the groove, and a shank extending through an opening formed in a distal end of the receiver member and configured to engage bone; and an engagement member disposed within the receiver member at a location substantially proximal to the head of the bone screw, the engagement being expandable into the groove, and the engagement member being effective to engage the head of the bone screw to provide sufficient friction between the head and the receiver member to enable the receiver member to be maintained in a desired angular orientation relative to the shank before locking the head within the receiver member.
 22. The device of claim 21, wherein the engagement member has at least one slot formed therein and configured to allow the engagement member to be contracted to provide sufficient friction between the head and the receiver member to enable the receiver member to be maintained in a desired angular orientation relative to the shank before locking the head within the receiver member.
 23. The device of claim 21, wherein the engagement member includes a concave distal surface configured to seat at least a portion of the head of the bone screw.
 24. The device of claim 21, wherein the engagement member is mated to the receiver member such that proximal movement of the engagement member is prevented.
 25. The device of claim 21, wherein at least a portion of the engagement member has a diameter that is expandable or deformable to frictionally engage the spherical head.
 26. A method for implanting a polyaxial fixation device, comprising: implanting a threaded shank in bone, the shank having a head formed on a proximal end thereof and seated within a cavity in a receiver member such that the receiver member is polyaxially movable relative to the head, the receiver member including an engagement member located substantially proximal to the head, the engagement member being expandable into a groove formed within the receiver member, and the engagement member engaging the head to provide sufficient friction between the head and the receiver member to maintain the receiver member in a desired angular orientation relative to the shank before locking the head within the receiver member.
 27. The method of claim 26, further comprising applying a locking element to the receiver member to lock the receiver member in a fixed position relative to the shank.
 28. The method of claim 26, further comprising positioning a spinal fixation rod within the receiver member, and applying a locking element to the receiver member to lock the spinal fixation rod within the receiver and to lock the receiver member in a fixed position relative to the shank.
 29. The method of claim 26, wherein the receiver member includes opposed side bores formed therein and having a deformable material extending thereacross, the deformable material being swaged inward into opposed detents in the engagement member to retain the engagement member within the receiver member. 